Provider Demographics
NPI:1427702471
Name:RICHARD, REBECCA HALEY (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HALEY
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 OAKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2924
Mailing Address - Country:US
Mailing Address - Phone:404-402-5524
Mailing Address - Fax:
Practice Address - Street 1:196 OAKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2924
Practice Address - Country:US
Practice Address - Phone:404-402-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0078051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical